Motor and cognitive function in lewy body dementia: Comparison with Alzheimer's and Parkinson's diseases

Department of Old Age Psychiatry, Withington Hospital, West Didsbury, Manchester, UK.
Journal of Neurology Neurosurgery & Psychiatry (Impact Factor: 5.58). 04/1997; 62(3):243-52. DOI: 10.1136/jnnp.62.3.243
Source: PubMed

ABSTRACT Motor and cognitive function were compared in patients with Lewy body dementia, Parkinson's disease, or Alzheimer's disease, to identify features that may be clinically useful in differentiating Lewy body dementia from Alzheimer's disease and Parkinson's disease.
A range of neuropsychological function and extrapyrimidal signs (EPS) was assessed in 16 patients with Lewy body dementia, 15 with Parkinson's disease, 25 with Alzheimer's disease, and 22 control subjects.
The severity of total motor disability scores increased in the following order: controls approximately = Alzheimer's disease < Parkinson's disease < Lewy body dementia. Compared with patients with Parkinson's disease, patients with Lewy body dementia had greater scores for rigidity and deficits in the finger tapping test, but rest tremor and left/right asymmetry in EPS were more evident in Parkinson's disease. Patients with Lewy body dementia were also less likely to present with left/right asymmetry in EPS at the onset of their parkinsonism. "Sensitivity" to neuroleptic drugs was noted in 33% of patients with Lewy body dementia. Alzheimer's disease and Lewy body dementia groups had greater severity of dementia compared with the Parkinson's disease group and controls. Neuropsychological evaluation disclosed severe but similar degrees of impaired performances in tests of attention (digit span), frontal lobe function (verbal fluency, category, and Nelson card sort test) and motor sequencing in both Lewy body dementia and Alzheimer's disease groups, than Parkinson's disease and controls. In the clock face test, improved performance was noted in the "copy" compared to "draw" part of the test in controls, patients with Alzheimer's disease, and those with Parkinson's disease, but not in the patients with Lewy body dementia, who achieved equally poor scores in both parts of the test.
EPS in Lewy body dementia resemble those seen in idiopathic Parkinson's disease, although less rest tremor and left/right asymmetry but more severe rigidity favours a diagnosis of Lewy body dementia. The unique profile of patients with Lewy body dementia seen in the clock face test suggests that this simple and easy to administer test may be useful in the clinical setting to differentiate Lewy body dementia and Alzheimer's disease.

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    ABSTRACT: The Lewy body was identified as the neuropathologic hallmark of Parkinson's disease in 1912. In 1961, Okazaki 1 first described a relationship between the presence of cor-tical Lewy bodies and dementia, later confirmed by oth-ers. 2,3 Based on several autopsy series, Dementia with Lewy bodies (DLB) is now considered to be the second most common form of dementia, accounting for about 20% of dementia, following Alzheimer's disease (AD) which accounts for about 60%. 2 DLB tends to affect males more than females and the age of onset typically falls between age 50 and 80, with a duration of illness of about 6 years. 4 It is considered to have a more rapid progression than pure AD 5 however in some patients the initiation of neuroleptic medication may be associated with increased morbidity and mortality. 6 Coronal MRI images reveal significantly greater medial temporal (hippocampal) atrophy in AD than in DLB or vascular dementia, a relationship that is related to sever-ity of memory impairment. 7 Early detection and differen-tiation of DLB from other conditions is important for determination of treatment options and to provide caregiv-ers and patients with information and resources to help behaviorally manage behaviors associated with DLB. Clinical Diagnosis In 1996, consensus criteria were put forth that identify 3 core features for the clinical diagnosis of DLB: fluctuating alertness/cognition, recurrent fully formed visual halluci-nations and spontaneous parkinsonism 8 (see Table 1). De-mentia plus two clinical features are needed for a diagnosis of probable DLB, and one for a diagnosis of possible DLB. Cognitive impairment typically precedes or coincides with the onset of the clinical features. 9 Studies addressing sensitivity (proportion of cases positively identified) and specificity (proportion of negative cases correctly identi-fied) with other neurodegenerative conditions using neuro-pathology have reasonably good specificity rates of about 0.80, but variable sensitivity rates. 10-12 This variability is at least partly attributable to mixed agreement regarding what constitutes fluctuations and difficulty differentiating be-tween DLB and AD late in disease course. When the analysis is confined to patients with dementia ranging from mild to moderate dementia, sensitivity ratings of DLB improve. 11 Further work is needed to identify whether the presence of other co-existant disorders serves to improve the diagnostic accuracy of DLB. REM sleep behavior disorder (RBD) occurs with a greater frequency in DLB relative to AD and may be a useful clinical indicator of DLB.

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